Pediatric Henoch-Schonlein Purpura Medication

  • Author: Pamela L Dyne, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Jan 4, 2011
 

Medication Summary

Treatment of Henoch-Schönlein purpura (HSP) is largely supportive. Analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen may reduce joint and soft tissue discomfort. The evidence does not clearly demonstrate that corticosteroid administration prevents the development of nephritis in patients with Henoch-Schönlein purpura, although its use in the treatment of intestinal and neurologic complications is gaining acceptance. If used, prednisone 1-2 mg/kg/d PO for 7 days is recommended. Antihypertensives may be indicated with renal involvement; for more information, see the pediatric topic Hypertension.

Other drugs are currently under investigation (see Emergency Department Care). For more information on long-term medication management, see the pediatric general medicine topic Henoch-Schönlein Purpura.

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Analgesic agents

Class Summary

Pain control is essential for quality patient care. Some analgesics (eg, acetaminophen, ibuprofen) are also effective for treating fever.

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Ibuprofen (Advil, Motrin)

 

Effective for treating fever or mild-to-moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Acetaminophen (Feverall, Tempra, Tylenol)

 

Inhibits action of endogenous pyrogens on heat-regulating centers; reduces fever by a direct action on the hypothalamic heat-regulating centers, which, in turn, increase the dissipation of body heat via sweating and vasodilation. Effective for treating fever and relieving mild-to-moderate pain.

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Glucocorticoids

Class Summary

Short-term use may be considered to decrease inflammation during neurologic or intestinal complications.

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Prednisone (Deltasone, Meticorten, Orasone, Sterapred)

 

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocyte and antibody production.

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Contributor Information and Disclosures
Author

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Stacy Sawtelle, MD  Clinical Instructor, Department of Emergency Medicine, University of California, San Francisco, School of Medicine

Disclosure: Nothing to disclose.

Heather Kesler DeVore, MD  Clinical Attending Physician, Assistant Professor Physician, Department of Emergency Medicine, Washington Hospital Center/Georgetown University Hospital

Heather Kesler DeVore, MD is a member of the following medical societies: Emergency Medicine Residents Association and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD  Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. [Best Evidence] Chartapisak W, Opastiraku S, Willis NS, Craig JC, Hodson EM. Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review. Arch Dis Child. Feb 2009;94(2):132-7. [Medline].

  2. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child. Sep 2005;90(9):916-20. [Medline].

  3. McCarthy HJ, Tizard EJ. Clinical practice: Diagnosis and management of Henoch-Schönlein purpura. Eur J Pediatr. Jun 2010;169(6):643-50. [Medline].

  4. Chang WL, Yang YH, Wang LC, et al. Renal manifestations in Henoch-Schonlein purpura: a 10-year clinical study. Pediatr Nephrol. Sep 2005;20(9):1269-72. [Medline].

  5. Gonzalez-Gay MA, Garcia-Porrua C, Pujol RM. Clinical approach to cutaneous vasculitis. Curr Opin Rheumatol. Jan 2005;17(1):56-61. [Medline].

  6. Lanzkowsky S, Lanzkowsky L, Lanzkowsky P. Henoch-Schoenlein purpura. Pediatr Rev. Apr 1992;13(4):130-7. [Medline].

  7. Martin J, Paco L, Ruiz MP, et al. Inducible nitric oxide synthase polymorphism is associated with susceptibility to Henoch-Schonlein purpura in northwestern Spain. J Rheumatol. Jun 2005;32(6):1081-5. [Medline].

  8. Tapson KM. Henoch-Schonlein purpura. Am Fam Physician. Feb 15 1993;47(3):633-8. [Medline].

  9. Ting TV, Hashkes PJ. Update on childhood vasculitides. Curr Opin Rheumatol. Sep 2004;16(5):560-5. [Medline].

  10. Tintinalli JE, Kelen GD, Stapczynski JS. Henoch Schonlein purpura. In: Emergency Medicine: A Comprehensive Study Guide. 6th ed. 2004:886.

  11. Trujillo H, Gunasekaran TS, Eisenberg GM, et al. Henoch-Schonlein purpura: a diagnosis not to be forgotten. J Fam Pract. Nov 1996;43(5):495-8. [Medline].

  12. Urbach AM, Londino AV. Rheumatology. In: Atlas of Pediatric Physical Diagnosis. 3rd ed. 1997:203-4.

  13. Urbach AM, Londino AV. Dermatology. In: Atlas of Pediatric Physical Diagnosis. 3rd ed. 1997:236-7.

  14. Yigiter M, Bosnali O, Sekmenli T, et al. Multiple and recurrent intestinal perforations: an unusual complication of Henoch-Schonlein purpura. Eur J Pediatr Surg. Apr 2005;15(2):125-7. [Medline].

 
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A 9-year-old boy with Henoch-Schönlein purpura. Note confluence of purpura around the ankles. Courtesy of Pamela L Dyne, MD.
A 7-year-old girl with Henoch-Schönlein purpura. Courtesy of Pamela L Dyne, MD.
 
 
 
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